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Policy Snapshot

February 23, 2024

White Paper Focuses on Greater Participation in Accountable Care Organizations

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) and the National Association of ACOs (NAACOS) jointly released a set of recommendations that were recently shared with the Centers for Medicare & Medicaid Services (CMS) that, if implemented, would increase the participation of long-term and post-acute care (LTPAC) providers in accountable care organizations (ACOs). AHCA/NCAL and NAACOS convened a roundtable of stakeholders, including the Society, in 2023 to address the challenges and, more specifically, develop recommendations on how LTPAC providers can more effectively participate in ACOs. 

Fewer than 2,000 skilled nursing facilities (SNFs) participate in ACOs, representing less than 10 percent of SNFs nationwide, and nearly 70 percent of ACOs have no SNF participation. Despite targeted partnerships’ ability to produce significant cost savings and care improvements, LTPAC providers face myriad challenges participating in CMS value-based care models, including ACOs. Current program policies in ACO models do not align well with LTPAC providers, including those that determine which patients ACOs are accountable for, setting financial benchmarks, and quality measures. However, as one of the highest-cost and most complex patient populations, LTPAC presents a significant opportunity for improved resident outcomes and reduced costs to the Medicare program. 

The paper focuses on two priority areas. First, how can existing risk-based arrangements—such as the ACO Realizing Equity, Access, and Community Health (REACH) Model and Medicare Shared Savings Program—be improved to increase SNF participation. Second, how can models better incorporate episodic-based payment within broader ACO arrangements? Ultimately, the roundtable recommendations were focused on five key areas: alignment/participation options for beneficiaries residing in LTC facilities, financial methodology, quality measurement, data, and future model concepts. 

The white paper with specific recommendations included is available online. AHCA/NCAL and NAACOS plan to continue collaboration on this effort to support a clear path forward in which ACO models better incorporate LTPAC providers.